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  • Title: [Outpatient emergency services].
    Author: Cara M.
    Journal: Bull Acad Natl Med; 1991 Mar; 175(3):351-61. PubMed ID: 1933460.
    Abstract:
    Emergency is felt very differently according to the level of education, and the sensitivity of the patient and his family circle. Pain is often the alarm but a physician only is able to appreciate the seriousness and the development of a seriously threatening emergency, which slowly evolves in their beginning but becomes degraded afterwards. The only victims who are operated on the first hour, the golden hour, take chance to survive. But there are only 2 or 3 golden minutes to rescue a cardiac arrest. Quicker an effective treatment is done, better the results are. If time is lost, a tissular hypoxia settle and lead to multiple organ failure especially in the brain. Then the dead come in more or less longer time whatever it is done: it's the irreversible shock which drive to the brain death. In the beginning the only patient and his family circle are able to do something. From that you can understand the importance of public education and alert organization for getting suited and early aid. The attending physician have to educate his patients as they are able to recognize the signs of a real seriousness. Telephone play an essential role especially because the dial 15 for health free call is now put in service in France. The phone questioning allows medical regulation of "SAMU-15" (EMS-dial 15 Centre) to dismiss most of the ill-founded calls and to carry the patient in an hospital able to immediately treat him efficiently. The emergencies organization is inspired by two principles: 1. without any loss of time all patient shall fully treated, possibly on the spot. 2. effective intensive care shall be done to avoid tissular hypoxia. Hence the rescue medicalization and the emergency medical system. These principles are the basis of organization of french SAMU whom control role is also to inform the receiving hospital for preparing the reception. The 6.1.1986 french law had defined the emergency medical system, legalizing the SAMU, and fixing their role in connection with policy and firemen. The equipment of ambulances is well standardized and they should radio connected with SAMU. Helicopters may give inestimable service to carry patients in well equipped center as U.S. trauma centres. Small hospitals should only treat small emergency according their means in personnel and equipment.
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